| Objective:Patients with different stress states(fracture,myocardial infarction)were selected as the research object,and fasting plasma glucose(FPG),fasting insulin(FINS),and fasting C peptide(fasting C peptide,FCP),glycosylatedhemoglobin(Hb A1c),osteocalcin(OCN),type 1 procollagen N-terminal propeptide(P1NP),type I collagen carboxy-terminal cross-linked peptide(?-C-termial telopeptide of type 1 collagen(?-CTX)levels,calculate insulin resistance index(HOMA-IR)and islet ?-cell function(HOMA-?)to analyze changes in bone turnover index levels and glucose metabolism under different stress conditions The relationship between bone metabolism and glucose metabolism during stress-induced hyperglycemia was explored.Methods:Ninety-five fracture patients admitted to the Department of Orthopaedics of the Second Hospital of Shanxi Medical University from October 2017 to January 2020 were collected(X-rays suggest that the continuity of the bone structure was completely or partially broken)as the fracture group.Patients with myocardial infarction hospitalized in the Department of Cardiology 59 Cases(coronary angiography combined with abnormal electrocardiogram)were selected as myocardial infarction group.At the same time,79 healthy people from our health check-up center matched with age and weight at the same time period were selected as normal group,and the duration of disease of all patients did not exceed 7 days.All subjects except type 2 diabetes with acute and chronic complications and bone metabolism-related diseases were collected for general data,and fasting blood glucose(FPG),fasting insulin(FINS),fasting C peptide(FCP),and glycated hemoglobin(Hb A1c)were collected.Osteocalcin(OCN),type I procollagen amino-terminal propeptide(P1NP),type I collagen cross-linked carboxy-terminal peptide(?-CTX).Calculate insulin resistance index(HOMA-IR)and islet ?-cell function(HOMA-?).Data were collated and analyzed for correlations between bone turnover marker levels and stress-induced hyperglycemia and glucose metabolism.Results:1.General data comparison between groups: there was no significant difference in age,course of disease,BMI,history of hypertension,serum thyroid stimulating hormone,urea nitrogen,and serum creatinine in each group(P <0.05);2.Changes of bone transition markers OCN,P1 NP,?-CTX between the three groups:Compared with the normal group and the myocardial infarction group,bone marker P1 NP and ?-CTX levels in the fracture group were significantly increased,and the difference was statistically significant(P <0.01).There was no difference between the myocardial infarction group and the normal group(P> 0.05).There was no significant difference in OCN in each group(P> 0.05).2.1 Changes in bone turnover markers OCN,P1 NP,?-CTX between the three groups when stress hyperglycemia is combined:When combined with stress hyperglycemia,the fracture group was significantly higher than the other two groups,the difference was statistically significant(P <0.01),the fracture group and myocardial infarction group OCN levels were significantly increased,the difference was statistically significant(P <0.01)In the normal group and the myocardial infarction group,the OCN level was significantly increased,and the difference was statistically significant(P <0.01).The levels of P1 NP and ?-CTX in the fracture group were significantly higher than those in the myocardial infarction group and the normal group when stress hyperglycemia was combined.The difference was statistically significant(P <0.01).The level of ?-CTX was significantly increased,and the difference was statistically significant(P <0.01).Compared with the normal group,the levels of P1 NP and ?-CTX in the MI group were significantly increased,and the difference was statistically significant(P <0.01).3.Changes in glucose metabolism indicators FPG,Hb A1 c,FINS,FCP,HOMA-IR,and HOMA-? between the three groups: FPG and HOMA-IR levels in the fracture group and myocardial infarction group were higher than those in the normal group,and the difference was statistically significant P <0.05).There was no significant difference in Hb A1 c,FINS,FCP,and HOMA-? among the three groups(P> 0.05).3.1 Changes of glucose metabolism indexes FPG,Hb A1 c,FINS,FCP,HOMA-IR,HOMA-? when stress hyperglycemia was combined between the three groups:FPG and HOMA-IR levels in fracture group and myocardial infarction group were higher than those in normal group during stress hyperglycemia,and the difference was statistically significant(P <0.01).Compared with the myocardial infarction group,the FPG and HOMA-IR levels of the myocardial infarction group were higher than those of the fracture group,and the difference was statistically significant(P <0.01).The HOMA-? in the fracture group and myocardial infarction group was lower than that in the normal group during stress hyperglycemia among the three groups.Compared with the myocardial infarction group,the HOMA-? level in the myocardial infarction group was significantly reduced,and the difference was statistically significant P<0.01).There was no significant difference in Hb A1 c,FINS and FCP among the three groups(P> 0.05).4.Comparison of bone transition markers OCN,P1 NP,?-CTX,and glucose metabolism-related indicators FPG,Hb A1 c,FINS,FCP,HOMA-IR,and HOMA-? in fracture patients: OCN levels in the fracture group were significantly higher than FPG,Hb A1 c,and HOMA-IR.Negative correlation(r =-0.256,r =-0.259,r =-0.283,P<0.01)has no significant correlation with FINS,FCP,and HOMA-?(r =-0.122,r =-0.102,r = 0.092,P > 0.05).There was no significant correlation between P1 NP levels and FPG,Hb A1 c,FINS,FCP,HOMA-IR,HOMA-?(r =-0.084,r = 0.015,r =-0.157,r =-0.152,r =-0.145,r = 0.128,P> 0.05).There is no significant correlation between?-CTX levels and FPG,Hb A1 c,FINS,FCP,HOMA-IR,HOMA-?(r = 0.044,r =0.128,r = 0.125,r = 0.032,r = 0.131,r = 0.071,P > 0.05)5.Comparison of bone transition markers OCN,P1 NP,?-CTX,and glucose metabolism-related indicators FPG,Hb A1 c,FINS,FCP,HOMA-IR,and HOMA-? in patients with fracture during stress-induced hyperglycemia: OCN levels and FPG in the fracture group HOMA-IR was negatively correlated(r =-0.449,r =-0.385,P<0.05),and the differences were statistically significant.OCN levels were positively correlated with HOMA-?(r = 0.375,P<0.05).The differences were statistically significant.Significance,no correlation with Hb A1 c,FINS,FCP(r =-0.226,r =-0.140,r =-0.108,P> 0.05);P1NP level was positively correlated with HOMA-?(r =0.376,P<0.05)The difference was statistically significant,and there was no significant correlation with FPG,Hb A1 c,FINS,FCP,HOMA-IR(r =-0.307,r =-0.256,r = 0.138,r = 0.102,r = 0.087,P> 0.05);There is no significant correlation between ?-CTX levels and FPG,Hb A1 c,FINS,FCP,HOMA-IR,HOMA-?(r =-0.153,r =-0.095 r = 0.276,r = 0.192,r = 0.094,r = 0.289,P> 0.05)6.Comparison of bone turnover markers OCN,P1 NP,?-CTX and glucose metabolism-related indexes FPG,Hb A1 c,FINS,FCP,HOMA-IR,HOMA-? when stress hyperglycemia occurs: when stress hyperglycemia occurs The OCN level of myocardial infarction group was negatively correlated with FPG and HOMA-IR(r =-0.483,r =-0.416,P <0.05),and the difference was statistically significant.The OCN level was positively correlated with HOMA-?(r = 0.395,P <0.05).The difference was statistically significant.No other bone turnover indexes were found to be related to glucose metabolism.The difference is statistically significant,and no other bone turnover indexes are found to be related to glucose metabolism.Conclusion:The level of indicators of partial response to bone turnover increases during fractures,and the rate of bone metabolism accelerates.At the same time as mediating bone tissue repair and remodeling,it can regulate insulin secretion and islet function by regulating osteocalcin levels,affecting the body's blood glucose levels.It is speculated that a large number of bone turnover markers can affect glucose metabolism,and the specific mechanism needs further study. |
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